Alleged Victim of Oxford Nutritionist ‘Detox Diet’ wins £810,000

Barbara Nash is a nutritionist based near Oxford. Dawn Page was overweight and sought the advice of Nash. It is alleged she was put on a ‘detox diet’ which included drinking lots of water and consuming no salt. If true, the result was very predictable.

Mrs Page suffered ‘uncontrolled vomiting and a fit’ and was rushed to intensive care. The Oxford Mail now reports she has brain damage. Her husband sued Dawn Nash and her insurers have paid out £810,000 in a settlement for compensation.

It is worth noting that Nash’s barrister said she was a.

“privately trained nutritionist”, and emphasised she continued to deny she was in any way to blame for what happened.

Barbara Nash appears not just to offer detox diets but also sells on her web site kitchen smoothie makers, blenders and juicers that cost more than a thousand pounds.

Anyone can call themselves a nutritionist. Only Dietitians are guaranteed by their training and professional memberships to be fully competent in what they do. Sadly, the proliferation of under trained and badly trained nutritionists is growing unchecked. Universities are in on the act taking money from students to train them as ‘nutritional therapists’. Such degrees, from the likes of the University of Westminster School of Magic, are a disgrace. Privately owned colleges appear to offer legitimate diplomas, but their standard of training is unchecked.

But the TV and the Sunday supplements are full of the stupid and dangerous advice about detox and vitamin pills and superfoods and allergy tests. It is quack nutritionists, rather than medical dietitians, who own the media and the attention of the public. It is a handy commercial partnership of supermarkets, quacks, health shops and pharmacies selling pills and tonics and books and over prepared foods.

And the government is not helping. Their new Prince Charles sponsored body Ofquack intends to regulate nutritional therapists. It will give them a veneer of professionalism without protecting the public one little bit. Ofquack refuses to regulate the practice of their members (what they believe and do) and only certify that they have been trained by other quacks and carry insurance.

Personally, I think the British Dietetic Association cannot escape some blame here for the growing rise of nutriquacks. This is the proper organisation that regulates real dietitians. They should be as mad as hell that their turf has been invaded by anti-science know-nothings. I am sure their members have to deal with the catastrophic results of patients who have been misinformed by nutritionists everyday. Where is the noise they ought to be making? Why are they not telling the public and government that something is terribly wrong here with they way we view food and the self-appointed gurus who profit from our confusion?

Until this is sorted out, I expect we will be seeing an ever increasing number of stories just like this.

On this theme…

46 Comments on Alleged Victim of Oxford Nutritionist ‘Detox Diet’ wins £810,000

  1. You are spot on – the BDA should be as mad as hell – and I bet their hard working members are. You would expect that the management of the BDA would be out in the media fighting the fight and ensuring that people think of Dieticians rather these quacks for nutritional advice.

    Instead the management of the BDA is actively undermining their own members. Their own Chief Exec Andy Burman is, incredibly, a member of the Complementary and Natural Healthcare Council’s Federal Regulatory Council. Check it out at the FIH website.

    Their Chief Exec should be doing everything possible to put dieticians out there as the subject matter experts and the safe option. Instead he is advising a council which will regulate these nutritional quacks and as a direct result make it more likely for the general public to consult one of these newly reglulated “nutritional therapists” instead.

    No wonder the dieticians can’t get their voices heard if their own organisation jumps into bed with the ememy.

  2. Anonymous – that is staggering. The Chief Executive of the BDA is in bed with the quacks? The BDA are doomed.

  3. I know. It is also very depressing.

    If you were to ask the general public very few know that Dietician/Dietitian is a protected title in the same way that Physio or Doctor is.

    The public are being denied access to sensible, evidenced based nutritional advice. Always this is advice that does not encourage them to part money for diets that don’t work and supplements that are unproven are unnecessary.

    Yet, like it or not, the media faces of nutrition are the likes of McKeith and Holford. I wonder how much time Dieticians spend disabusing the general public of some wacky notion they have picked up from non evidenced based nutritional practitioners?

    The BDA should be in the face of every media outlet demanding a dietician on the sofa at GMTV or on radio 5 live to talk some sense. Instead, their Chief Exec is actually spending his time regulating the very people that are putting the public at risk.

    It really is incredible that the members of the BDA tolerate such outrageous poor judgement from their leadership. Maybe they are unaware. Although you would assume the BDA operating committee (or whatever they have) either cannot know (which is hard to believe) or do not consider this a conflict of interest (which frankly should render them unfit to hold such office).

    If the people representing the Dieticians don’t care about the march of the quack nutritionists (and in fact are helping them to gain recognition) – and you have to say that the dieticians themselves don’t seem to be making much noise about it (maybe they are but their organisation is just useless at giving them a media voice) – then really what hope is there for the rest of us who merely believe in the simple idea of Science Based Medicine that has served us so well for over 100 years?

    Might as well all raise a white flag to McKeith, Holford et al and face the fact that evidence based nutrition is a dead duck.

    Very depressing.

  4. It would not be so bad if Ofquack was actually going to be in the business of protecting the public. But this is the one thing that they cannot and will not do. As such, Ofquack is a total distortion of the original aims of the House of Lords and the government has allowed it to be hijacked by quacks, not least the Prince of Wales and the ‘Integrated Medicine’ dissemblers.

    Will Ofquack be able to stop people like Barbara Nash from practicing? No.

    Will Ofquack give a guarantee that their members’ advice and practice is safe and evidence-based? No.

    Will Ofquack provide fig leaves of respectability and ‘professionalism’ to quacks? Yes.

  5. Is the chief exec of the BDA further providing legitimacy to the very nutritional therapists that are a danger to the public and in doing so professionally humiliating his own members? Yes.

    Should dieticians now be demanding a change of direction and chief exec at the BDA or just abandoning the pointless organisation? Yes.

  6. As far as I can tell, RDs have consciously ceded the battle for media attention. Why do those attractive RDs with a media profile allow themselves to be referred to as nutritionists rather than RDs? I understand that they are qualified as both but they must be aware that they are confusing the public about the
    standing and implicit competence of RDs and nutritionists.

    Because these weird hybrids don’t wish to offend anyone, they never challenge the assumption that we need to detox when they are asked questions about it. Apart from BDA spokeswoman Catherine Collins, I’ve never heard any other RD challenge the relevance of blood tests for food intolerance and suchlike.

    It is confusions like this that encourage people like Mrs Page to attend a nutritionist. On which topic, it is predictable but saddening that the nutritionist in question is still pushing the benefits of hydrotherapy and warning people of the dangers of salt.

  7. I am a proud HPC registered Dietitian and up till recently I was also a proud member(albeit diminishing) of the BDA. However on discovering that my very own Chief Exec Andy Burman is, a member of the Complementary and Natural Healthcare Council’s Federal Regulatory Council I am truly mad and embarrassed.

    The BDA do have members who are proactive in the media and who feel passionately about ensuring that qualified people advise and speak about nutrition BUT the BDA relies on them doing this on top of their 9-5 job (wherever that might be – NHS Freelance) instead of taking a proactive view and recognising the importance of getting us out there on a more regular basis. It is utterly depressing to think that of the hard work that I try as “little old RD” to stop the likes of McKeith, Holford et al and ensure that good quality evidence based nutritional advice is shared with the public and then to find out that my own organisation is “allowing” the Chief Exec to be part of this!!!!

    It is a very good question raised above– “Should dieticians now be demanding a change of direction and chief exec at the BDA or just abandoning the pointless organisation”?

    Unfortunately this is not just a sad day but I fear a sad episode that my professions in entering into.

  8. I like her photo, I guess she thinks it shows her gaising at the sky, deep in profound thought, where as in fact she looks like she’s staring vacuously into space waiting for the next idiotic idea to pop into her head.

  9. Drinking large amounts of water without compensating consumption of electrolytes (salts) can result in an osmotic shift in cells and cause damage.

    Do you remember Leah Betts who died after ‘ecstacy’ consumption? It was the water she was drinking that killed her.

  10. The problem is you take qualifications to mean something and some people are very plausable.

    I have spent thpousands of pounds trying to improve my health including food intolerance tests and was prescribed dozens of vitamins that I was “short” of at the Breakspear Hospital – by a Dr.

    After about three weeks I could not tolerate the vitamins and if I had cut out everything the Breakspear said I was intolerant to I would be eating fresh air.

    These people all have medical qualifications – you would think that someone would review their conduct.

  11. If you have a concern about a real doctor then you should contact the GMC and complain to them. If they have abused your trust then they will be struck off and not allowed to practice.

    That is not the case with nutritionists. No one can tell them that they cannot practice. Nash is free to do whatever she wants despite the severity of these allegations.

  12. And therein lies the problem. If the BDA represented their members properly the general public would know that people could visit a Registered Dietitian to get safe, insured, evidence-based nutritional advice.

    But they don’t. No lay person has any idea of the status of RDs. And nor will they continue to if the BDA continues to ignore the growing threat of quack nutritionists.

    It is too easy to blame the Holfords of this world but surely the BDA are the main culprits for this lack of public awareness – closely followed by the dietitians themselves who don’t seem to be addressing the malaise in their own professional organisation.

    If it was my union I would be of there in a shot. What’s the point?

  13. Does the GMC really have any teeth. Please see document below from BMJ

    BMJ 2006;333:722 (7 October), doi:10.1136/bmj.333.7571.722-h

    News extra

    Director of private hospital is cleared of falsely claiming NHS employment
    London Owen Dyer

    The founder and medical director of a private day hospital was cleared this week by the General Medical Council of falsely claiming on her curriculum vitae to have been employed by five major NHS hospitals.

    Jean Monro, medical director of Breakspear Hospital in Hemel Hempstead, was accused by the GMC’s fitness to practise panel of writing a “dishonest” CV with intent to mislead. Dr Monro claimed to have been medical director of the “allergy and environmental medicine department” of the Middlesex Hospital, the London Welbeck Hospital, the Lister Hospital, the St John and St Elizabeth Hospital, and the Nightingale Hospital.

    In fact she was never employed by any of these hospitals but had been medical director of private clinics that leased accommodation on their premises.

    The CV came to the attention of the GMC in 1998. After reviewing the case the GMC chose not to pursue a case against Dr Monro but instead wrote to her, warning her: “Your CV can be interpreted as implying that you were appointed by each hospital to run a department within that hospital. Such an implication is clearly without foundation.”

    Dr Monro wrote back to the GMC disagreeing with these conclusions. The GMC then sent Dr Monro a second letter, noting that the matter was procedurally closed, but warning Dr Monro: “You might want to consider amending your CV.” Failure to do so might result in further action by the GMC, the letter warned.

    But at last week’s hearing the counsel for the GMC, Andrew Hurst, acknowledged that at the time the organisation had no formal powers to issue such a warning or any mechanism for Dr Monro to challenge it.

    In 2003 and 2004, when Dr Monro sent copies of her CV on request to David Black, director of public health at the now defunct Chesterfield Primary Care Trust, the CV still described her as former medical director at the five hospitals.

    But the GMC found that she had altered the CV to include the statement that “Sunbury Hill Clinic was involved in leasing accommodation” at the hospitals in question. The CV has since been amended again, to clarify further the nature of her employment there.

    The fitness to practise panel concluded that it could not sustain the charge that Dr Monro had failed to respond to the GMC’s earlier concerns or the charge that the CV was misleading, dishonest, or unprofessional. Dr Monro’s fitness to practise was therefore not impaired.

    The GMC “took into account that, although Dr Black’s evidence was that he had found your CVs misleading, the panel was aware that he had prior knowledge of the complaint that had been made about you in 1998.”

    Dr Black told the BMJ that he had asked for Dr Monro’s CV with a view to possibly contracting services but said he could not comment further.

    Alister Monro, Dr Monro’s son and the manager of Breakspear Hospital, said Dr Monro was “obviously pleased with the decision but had been legally advised not to make any significant comment for now.”

  14. An excellent post, Little Black Duck, with comments that highlight the frustration of being a Registered Dietitian in the UK today.
    Now, if only we could make up headline grabbing quotes, like, say ‘Sales Of My Vitamin Pills Are Better For My Profit Margin Especially When I Call Them Better Medicine Than Your Medicine’, or ‘Your Poo tells Me You Are a Gullible Fool who I can Humiliate On TV’ we’d be quids in.

    Our HPC Code of conduct prevents us from exploiting our knowledge in such a manner. Just like we can’t divulge which public personalities we’ve helped, or state we know more about nutrition, its role in health and disease and potential concerns compared to the wannabee pseudodietitians out there.

    Why on earth would all the media docs, self-styled guru’s and enthusiastic amateurs who ‘practice’ nutrition (practice being the clue, here) want to diss dietitians?

    Because our presence highlights their deficiencies. Everyone of us can do ‘nutrition lite’. The devil is in the detail.

    I share your concern and that of respondents that our professional organisation needs to take the matter in hand. The public deserve no less.

  15. Excellent post.

    This mirrors much of what has gone on in my own profession of Podiatry. Until the HPC came into being, the titles ‘chiropodist/podiatrist’ were unprotected. Anyone could call themselves such with no training and could be happily treating patients with potentially limb-threatening conditions. After the HPC came into being the titles became protected, but now the private training schools, to get around this, train people who call themselves Foot health professionals. These training schools are unchecked.

    The problem is that as a profession we, and the dieticians, have so far failed to get functional closure of our respective professions. This is unlike dentists for example who have the legal right in law to be the only people who treat mouths and teeth.

    Until dieticians and podiatrists obtain functional closure of their specialised roles in healthcare we will continue to see quacks making up inventive names for their little psuedo-professions and duping a trusting public.

  16. Andy

    I live in Oxfordshire where Barbara Nash is based.

    Beside me now I have the brochure for Oxfordshire Country Adult Education Services. They are offering Saturday workshops in nutrition; aromatherapy; reflexology; Chinese medicine; acupressure; holistic facials; kinesiology for wellbeing; and Herbs & Crystals for Health.

    The quactitioners will, I am sure, take everyone’s name and email before the end of the day to send them newsletters with the latest exciting research.

    The Oxfordshire branch of the BDA should be demanding they lead any workshops on nutrition. I am sure there are newly qualified dietitians who would be glad of £100 (or whatever) the fee is to lead a Saturday workshop.

    Has anyone else got any experience of tax payer funded adult education services subsidising quackery in their locality?

  17. derrik,

    you have read my thoughts about her face 🙂
    And do you know why does such impression appear? She has idiotic make-up. As a rule, only silly women paint their faces by this way ;))
    Generally, all ladies from CAM are silly, but (unfortunately for other people) too active…

  18. BBC local news covered the story on Tuesday evening and, I am told, ITV did likewise yesterday.

    Apparently the incident occurred in 2001. The family originally asked for £2million.

  19. The newly formed Complementary and Natural Healthcare Council (cnhc.org.uk) has been constituted to establish a system of voluntary regulation for those professions who seek to assure the public that they are properly trained and regulated. It has the support of the Department of Health and others who have been campaigning for regulation of complementary therapies for some years. Whether anyone believes in the efficacy or appropriate use of complementary and natural healthcare is a somewhat different issue: the fact is that the public uses it and sees value in it. Those of us who are committed to public protection will seek to ensure that the highest possible standards of education, training and practice are maintained.

    My role on the Council is not linked to my role as Chief Executive of the BDA and the BDA as an organisation is in no way linked to the new Council, I have been appointed (in a personal capacity) for my experience of professional statutory and voluntary regulation over many years and I hope to use that experience to ensure that the highest standards of practice are maintained and that the public are protected to the best of the Council’s ability.

    All professions should welcome debate about these issues and any members of the BDA are encouraged to have that debate and consider what approaches the profession should take and what strategies to adopt. There are mechanisms within the profession for members to take part in such debates. As there are many ‘anonymous’ postings I am not aware of who is commenting but any BDA members will be aware of the web discussion pages and committee structures to do so.

    There needs to be greater public awareness of the role of dietitians and what they can provide, as well as why dietitians are safe and competent professionals. However this fails to address the issue of public protection with regard to complementary therapies. Much of the discussion on such blogs and discussion fora is about the risk the public face in being treated by ‘quacks’ or incompetent practitioners. The core issue is what can be done about it? Outlawing such practices is not likely, ignoring it seems irresponsible and statutory regulation is not going to happen for many years, if at all. Therefore the only realistic immediate prospect for public protection is to seek an effective system of voluntary regulation. For this reason the Council has been supported and as someone experienced in regulation I am committed to seeking to ensure the highest standards of professional education and practice. I should also add that Nutritional Therapy is but one small part of the Council’s planned role. Like the Health Profession Council we seek to cover all the professions that wish to join us and there are several which have expressed an interest in joining the planned new register.

    I have posted these comments to clarify a few issues and in response to comments made about me personally. These were brought to my attention by other interested persons who thought I perhaps should know about the debate. As no-one had contacted me directly for clarification I have posted a response. I am unable to take part in further discussion through this forum but if anyone would like to contact me through the BDA (as a BDA member) or the CNHC (as a member of the public) then I would be pleased to hear from you.

  20. I too agree that there should be stricter controls in place and more guidelines for the general public, but what the media hasn’t covered is human error and not on the part of the therapist. Why do you think the settlement was for half of what was asked? Because there was a question of whether the client drank LITRES vs PINTS as advised. These sorts of cases are never as straightforward as we who would stand to benefit from a particular point of view would like. This was settled out of court because NEITHER party could prove their truth and neither set of lawyers wanted to risk losing the money invested in the case. Wake up kids…this isn’t about nutrition. This is about greedy lawyers who seriously don’t care and let the insurance companies clean up their mess.

  21. Litres or pints of water – legal semantics when the key issue was that the therapist was obviously clueless when the ‘red flags’ of confusion, muscle weaknesss and other typical symptoms of hyponatraemia presented themselves. What one could refer to as ‘unconsciously incompetent’.
    That is the issue – not the units of water consumed.

    Bear in mind that this is the sort of individual that the CNHC will ‘regulate’. At least it will make it easier for the patients family to seek redress after the harm has been done.

    This is what the CEO of the BDA, Andy Burman, should be considering when he attempts to placate his critics that to work with the CNHC is tacit endorsement of its shallow nutritional practitioners

  22. Anonymous said:
    “this isn’t about nutrition. This is about greedy lawyers who seriously don’t care and let the insurance companies clean up their mess.”

    No, it isn’t. It’s about a woman who died because she was given misleading information by an over enthusiastc amateur who didn’t recognise symptoms of hyponatraemia.

    If she hadn’t been so incompetant as to give lethal advice to someone, lawyers would never have been involved.

    • Did you know that the lady did not listen to what the nutritionist had recommended? there is a lot more to this whole situation than the public realise. The client was recommended a normal healthy eating program, she was also recommended reasonable levels of water which was 4 pints a day, then 4-6 pints (not other fluids on top of the 6 pints!), that is not copius amounts unless drank in a short space of time. That is less than a mug of water an hr!!!! There were other factors involved in this case as their usually is, I would like to point out that there are thousands of miscarriages of justice every year where experts have got their opinions wrong!! In this case the media went straight for the jugular of the nutritionist to start more media coverage on regulation. The nutritionist was stitched over by how the judicial system operates, have you ever been caught up in a no win no fee legal situation, probably not and I hope you do not because invariably whether you are guilty or not guilty these cases are still settled out of court because of the huge costs of high court. In the meantime the lawyers make a lot of money out of this type of case!!! Perhaps intelligent people don’t judge until they know the full evidence which could not be produced because the nutritionist was told she could be sued again if she went public and explained her version of events.

  23. I’m sorry – I find the response from the Chief Exec of the BDA beyond belief.

    How can you possibly maintain standards for stuff that doesn’t work? All you will do is provide legitimacy to those practitioners who do not maintain the high standard of your own members (who, by the way – must be absolutely livid that you are choosing to tacitly support quack therapists by providing legitimacy to them via regulation).

    The only people who are going to benefit are the quacks themselves. Patients who need nutritional advice are not. Indeed by doing what you are doing you will make a “nutritional therapist” more attractive than they are at a time when your own members are sinking in a sea of pseudoscience.

    There is a really easy way for the public to be protected from quack nutritionists like this – do your day job properly and make Dietitians the first and only port of call in the public consciousness for sound nutritional advice.

    Instead you will drive would be patients away from your own people. Biting the hand that feeds is the analogy that comes to mind.

    The council which you are helping to set up will make the Barbara Nashes of this world more prevalent – and give them respectability.

    Given that the BDA is clearly doing a shocking job of educating the public and you are personally responsible for giving “the enemy” more respectability I find it hard to understand how someone with so little regard for their own members and such poor judgement can still be in such a post.

    I quote the Canard Noir himself – consider these points when justifying to your own members how you can spend your free time shafting them:

    Will Ofquack be able to stop people like Barbara Nash from practicing? No.

    Will Ofquack give a guarantee that their members’ advice and practice is safe and evidence-based? No.

    Will Ofquack provide fig leaves of respectability and ‘professionalism’ to quacks? Yes.

  24. Over on HolfordWatch, we have a commenter (nutritional therapist) who is calling for the reduction of GP services etc. and workshops run by nutritional therapists to take their place.
    ———
    “Lets close the doors of all G.P surgeries and replace them with nutritional therapists. Lets spend time educating communities on the relationship between diet/nutrition/stress and the symptoms they suffer from. Lets prevent rather than cure. Instead of offering drugs that may clear up one symtom but probably cause some other ones, lets send patients to educational workshops…

    Obviously i dont actually want to close GP centres but this would also be a good expeiment.
    I would say after a few years of not demanding people take drugs and instead provide education and functional medicine, promoting lifestyle and dietry changes according to the individual and symptoms, death rates would drop dramatically.”
    ———–
    Yes – if you want a death knell of the profession of evidence-based dietetics, then accredit the nutritional therapists so that the public can’t tell the difference between their wibble and the RDs.

    Accredit these people who are anti-vax and :
    *think homeopathic vaccination for meningitis is ‘worth trying’;
    *push the diagnosis of ‘food allergies’ through blood tests, dowsing and kinesiology;
    *who diagnose nutritional deficiencies through dowsing, kinesiology and hair analysis;
    *who promote chelation for autism; *who promote GFCF diets on the basis of urine tests that measure something that really isn’t there…

    And, of course people will think that the CNHC accreditation or BDA accreditation of nutritional therapists will mean something. If you want to see how standards marques are abused – have a look at the defence that various device manufacturers have tried to run with the ASA that a EU mark meaning that something is electrically safe means that their device is validated. YorkTest tried to run a similar argument related to IVD Directive Annex III Section 6, (which covered the self test (consumer) aspect of the tests as medical devices) about their food intolerance blood test kits.

  25. “death knell of the profession of evidence-based dietetics” – very well put. No doubt the new CNHC accreditation will give people like your NT correspondent additional weight to push such anti-scientific views.

    The response from the BDA chief exec showed that he clearly does not consider this a threat. Which presumably means he doesn’t read the paper. Or watch TV. Or look at blogs. Or (most damningly) doesn’t court the views of his own members.

    Anything voluntary is going to be driven by the self interest of the organisations impact. So if BANT (for example) decided to sign up to the CNHC voluntary code it can only be because they think it will have a direct positive link to them getting more credibility (which can only possibly be at the expense of the BDA) and more work for their members (which can only be at the expense of the dietitians and their potential clients that have strayed from the correct path). BANT (for example) would not possibly consider signing up to CNHC if it was going to result in fewer people consulting their members.

    I remain astounded that anyone could be so naive as not accept that. As a concerned citizen I really hope the BDA get their house in order and start addressing this threat. Can’t see how that is going to happen though with their own Chief Exec taking a course of action that directly impacts his own members and the public generally.

    Very depressing for anyone concerned with the rise of quackery.

  26. Somebody has probably already said this, but the BDA do not regulate dietitians – it’s the Health Professions Council (HPC). But I am absolutely appalled by what has happened to this lady, but one cannot blame the BDA when the media make it increasingly hard for dietitians to get their message across, by giving columns and airtime to idiots like Gillian McKieth and Patrick Holford to spread their garbage because it has more of a ‘wow’ factor, or sound more fantastical than following a healthy diet with regular exercise.

  27. I completely agree with the previous registered dietitian about being ashamed about the position of the chief exec of the BDA. I too am a registered dietitian, I work part time as I have 4 children, one with special needs. I have recently attended the ‘relaunch’ of the London Branch of the BDA. AT this evening there was a brilliant presentation by Catherine Collins, who is passionate about promoting the excellent and very important role of dietitians, in primary , secondary and tertiary health care. She certainly is THE voice of dietitians and was she made some very important points about how to promote ourselves. It means putting ourselves out there and making noises. Unfortunately, I feel dietitians on the whole are quite a humble lot and do the job to help others not to make money. This needs to change, in the new London Branch there are 2 PR committee members who I feel are going to start making some noise. It’s going to take time but I have every faith the British Dietitians will soon be rising head and shoulders above the ‘nutritional therapists’ and shouting about our abilities and strengths and IMPORTANT role we play in the overall health of the UK.

  28. I’m currently studying to become a dietitian, and have just finished the first year of a four-year BSc and my first hospital placement. I agree that the BDA is not doing nearly enough, and was disappointed to hear of Andy Burman’s role in the CNHC and dissatisfied with his response here.

    There is one point I don’t think anyone has brought up here yet. There are only about 6,000 registered dietitians in the UK (http://www.bda.uk.com/JoiningtheBDA.html), which is roughly about one for every 10,000 people, so realistically there is no way, at the moment, that they can be the first port of call for everyone for nutritional advice. Numbers on degree courses are strictly limited and are agreed with the NHS (as they fund the degree courses) apparently to reflect the demand that the NHS has for dietitians. Yet for the last couple of years I’ve been hearing how difficult it is to get a job on graduation, and how many people have ended up abandoning dietetics and going into other fields of work entirely. Yes, there’s private practice, but the impression I’ve always been given is that it’s unethical to go straight into private practice after graduation until you’ve got some solid NHS experience under your belt.

    I think, as well as raising awareness in the general population, the BDA should be lobbying government and the NHS to help it in that task. I mean, what’s to stop the NHS/DoH/FSA putting a standard paragraph into their health promotion materials informing people that a registered dietitian is the person to trust for nutritional advice?

    But there’s no point getting that message out to people if they can’t get a referral to a dietitian because there aren’t enough of them. Most if not all dietetic departments have some form of screening process because they can’t see everyone who is referred, and so limit the cases they see to whatever criteria they have decided are most appropriate. I’m sure most dietitians feel they would like to see everyone who comes to them, but that’s not possible under current conditions.

    So the BDA also needs to be devoting a large amount of its resources to lobbying the government/NHS to start taking nutrition and dietetics seriously, and to put its money where its mouth is and cough up the cash for more training and more jobs to increase the number of qualified registered dietitians in the UK.

  29. @ anonymous (1st on on July 18) – when you say “but one cannot blame the BDA when the media make it increasingly hard for dietitians to get their message across” – i have to disagree.

    You absolutely can blame the BDA. If their own professional organisation isn’t going to get out there and promote dietitians who is supposed to do it? Do you really think it is acceptable for the BDA to just sit back and hope the media come to them? The NTs are excellent at self promotion, the fact that the BDA are doing nothing about it is entirely down to them.

    You might take it further – as you correctly point out, it is the HPC not BDA who regulate dietitians. And clearly the BDA are going a terrible job promoting dietitians in the media. So if the BDA aren’t there to regulate or promote dietitians what is the point of them?

  30. So what is it we should be doing about Nutritional Therapists? What I don’t understand is, apart from the new regulatory body, what is it that everyone thinks should be done about them?

  31. “There is one point I don’t think anyone has brought up here yet. There are only about 6,000 registered dietitians in the UK (http://www.bda.uk.com/JoiningtheBDA.html), which is roughly about one for every 10,000 people, so realistically there is no way, at the moment, that they can be the first port of call for everyone for nutritional advice….

    …Yet for the last couple of years I’ve been hearing how difficult it is to get a job on graduation, and how many people have ended up abandoning dietetics”

    A crucial point. We need to see articles in the national media about why it can be so hard in some areas to access specialised dietetic advice and we need to be contacting our MPs and putting pressure on them to put Parliamentary questions about this.

  32. Hallelujah!

    Finally Dietitian’s are finding their voice and are wanting to stand up and be counted. Sadly however it has taken this frightening situation to bring this matter to the forefront.

    The BDA do little if anything to promote us as Dietitians in the media and with the general public and we ourselves as a rule also are not the best at blowing our own trumpet. But let’s face it – if we don’t and our Professional Association don’t then who exactly is going to?

    If the likes of Gillian McKeith can buy their qualifications and tantalise the public with their evidence’less’based practice, whilst we stand by the sidelines and just spectate – then something is seriously wrong!

    We however as a profession and individuals need to take greater reponsibility. All of us should be looking to raise our profiles and supporting each other both as individuals and as groups. Wether that is locally or nationally via tv, radio, local and national news and media articles, meet and greets with the general public or publicising our patients inspirational success stories in the press.

    How often can you pick up a magazine article or newspaper that has a ‘weird and wonderful’ nutriton feature covered by a ‘health writer’ or dubiously titled ‘nutritionist’? And how many ‘fad’ diet’s are out there – Go to any newsagent and you’ll find shelves full of magazines with ‘fad diets’ and very few Dietitian’s out there detailing the ‘facts’ on nutrition and health. Isn’t that what we’re trained for?

    If we don’t fight for us and what we stand for and the knowledge each and everyone of us has trained so hard and so long, then we don’t really have a chance to change the future of how our profession is seen or indeed should we complain when incidents such as these occur if we haven’t done anything to change how things are?

    Each of us should stand up and be counted and respected as the clinicians that we are and for the work we do and the expert knowledge we have….and that means working on our marketing, PR and publicity skills.

    Dietitian’s it’s time to say ‘Move over to the like’s of McKeith and Holford’ … and make way for us the True Clinical Nutrition professionals….That’s what we worked for that’s why we were credited with our protected titles – what use is it if we don’t enforce what we have…

    Ladies and Gentlemen It’s time to reclaim the place that is rightfully ours and maybe look at who we choose to represent us -because let’s face it in any other business our PR agency would have been well and truly fired by now!

  33. Harley Street Dietitian
    you have a point. The BDA should be doing more – but so should the HPC, the regulatory body that ‘protects’ the use of title.

    Its interesting how many woo nutritionists come up when you type the word ‘dietitian’ into a search engine -they’ve added the name for direction. They also claim to work ‘with dietitians’. In their dreams. But punters may be convinced.

    Just how many sites has the HPC challenged for misleading the public? And are they publicising it to the interested public?

  34. yes however the number of deaths by quacks is still far lower than death by genius all knowing fully trained at our expense doctors. But sadly it is so commion place it is no longer news worthy!!

    At the great sadness is that as a fundamental part of our education this woman and the quack did not know some basic facts about the human body. We are all responsible as a society.

  35. Anonymous says:

    “yes however the number of deaths by quacks is still far lower than death by genius all knowing fully trained at our expense doctors”

    Question – how do you know?

    Answer – you don’t.
    Iatrogenic death will be published via the Coroners Court findings. Woo-death?

    Who knows?

    No way of reporting it even if you suspect it. Takes a legal approach by the family or others to ever bring it to attention

    http://www.sciencebasedmedicine.org/?p=136

    http://www.bmj.com/cgi/content/full/328/7438/485-c

  36. I am an RD working in Eating Disorders and I have to say that I am appalled at some of the nutrition nonsense that some Nutritional Therapists tell their patients. I get a considerable amount of EDO patients referred to me, via their GP, AFTER they have been to see an NT. When I contacted one NT with respect to a previous patient of hers (I needed to get some information on what she had covered with the patient), the NT said to me that she was relieved that I had taken over dietetic management of this patient as she (the NT) couldn’t cope! And the claptrap she had given the patient was worrying to say the least. AND this NT was on the BANT register.

    I’m also very concerned at the news about Andy Burman. Maybe we should be reviewing his position as CEO of the BDA.

  37. I see that a soon as a nutritionist makes a mistake, the knives come out for all non-dietitian advisors. What happened in this case was dreadful. But the actions of one cannot be generalised to the actions of all. That's like saying that all doctors behave like Harold Shipman! Not only that, we see that CAM does work either. Nearly all "mainlineliners" miss the point of CAM. Many CAM practitioners are approached after mainline medicine has given up on them. "mainlineliners" spout "evidence based medicine". I guess they are trained to believe that only the evidence in top journals, covered by double blind trials should be used. Nothing else has been proved to work, so it doesn't. I count myself fortunate that I stumbled upon CAM nutrition. If I had followed the advice of my doctor & RD, I probably would be deep into the side effects of T2DM by (after ~15 years). At diagnosis my BG was somewhere in the stratosphere. To be fair following the standard advice took me into reasonable regions, but I had to keep taking loads of tablets. Then by chance, I discovered a diet & regimen that took me to normal levels within a week. Astounding. So then I set about researching why and discovered that the standard min-line advice for diabetes is not based on any evidence. I looked very hard, but found only authoritative opinion. Not only that the mainline dietary advice given to everyone is based on the plate model or the USDA food pyramid. I failed to find any double blind trials proving these models. If anyone can find the evidence, I'd gladly look at it. In the meantime I'll keep my BG level and vision perfect by going my own way. I've now studied CAM nutrition for 5 years. If it is damn easy to get a qualification, why is my course so difficult? If CAM nutrition "doesn't work", why dos it work for me? Why is it so hard to dig out the evidence. (I'd never use anything that was not based on evidence) but RDs tell me it isn't evidence because its not double blind and peer reviewed. I'm not disrespectful of RDs: they do lots of things for which their specialist training is essential, but I do wish someone who really understood looked at some of the basic tenants on which their evidence is based. A cynic would say that what they are taught is designed to keep patients taking the medicine, not improve their health. It was certainly true in my case, but that's "anecdotal".
    It is not the registration that is important. It is the quality of the courses. Most quality NT courses have been validated by universities – but the RDs still say that what they are taught is wrong. They believe absolutely in their evidence base, which I've found to be very elusive in certain areas, so will they believe forever CAM nutrition to be erroneous?
    We need to be very clear about the difference between accurate dietary advice and the training given to those able to deliver it. On the one hand RDs say they hold the truth about nutrition and all untrained RDs are fakers and charletans. I doubt they hold the truth about nutrition, but would agree that their training is of the highest quality. Leaving aside the issue about nutritioal truth, we need to make sure that those qualified to deliver CAM nutrition receive training of an equally high standard. This can only come by having a registration body which sets the standard for and the verification of courses. This is precisely what the NTC have been trying to do since ~2002. Of course if you believe CAM nutrition is invalid, you will just see this as an endorsement of quackery. It is quite clear that neither the practitioner in this case nor the institution where she obtained her "qualification" were endorsed by the NTC.

  38. I think Andy has made his position untenable – the membership is mad as hell.
    Those of us who work in the private sector have all dealt with clients that have seen these therapists – some of the rubbish they sprout is quite unbelievable. The new council I think is a sham – and the NTs themselves do not want any more reg because they will end up halfing their income from all the supplements they sell

  39. Oh dear, I think I’m quite depressed now. What isn’t being mentioned here is that a big part of the problem is with the consumer. They don’t want to be told to eat less junk and get some exercise, they want to be told that they have an intolerance to this or that, that there’s a simply, interesting solution to their problem.

    I feel a bit sorry for Andy Burman here. He’s got involved in somthing that he feels will help the situation by turning absolutely no regulation at all into at least some and is getting absolutely shredded for it. It doesn’t make it difficult to see why very few dietitians are actually willing to put their heads above the parapet.

  40. Re comments on BDA raising their profeile – as previously staed Dietitains working in the NHS are in the position of struggling against lack of funding and understaffed departments. Many are overworked and demoralised. To ask these members of staff to work in their free time to promote a profession that they are becomong disillusioned with is a step too far.
    By the way, recent contact with the BDA PR office got us this reply;
    ‘I think the the BDA and dieititians need to be more proactive and more creative in how we tackle the issues facing dieitians, not just from nuts. We don’t have the budgets that some of the bigger corporates have and your subscriptions alone isn’t going to pay for a large scale advertising campaigns that you propose. You give me £3000 a month and I’ll get you plastered in all the newspapers and radio – guarantteed! (That’s what the PR agencies are being paid by the supplements companies!).’
    Scary thought – on top of wages rising below the inflation rate and caseloads that would beat a navvy down, we have to pay to promote our service! Unbelievable!

  41. People know what’s good for them.

    not necessary to go too far. if you want to play better living through science or in chemistry, that is not what is troubling 95 percent of the obese population today. like I say they know the difference between an apple and a cookie…
    the knowledge is there it has been there if they don’t care to be a student so be it
    sit there in your chair until your b*** is a square

  42. Whenever I hear the terms “practitioner, therapist, highly-trained” I shudder. I recently came across someone who’d been placed on some pseudo-scientific diet by one such nutritional therapist, which involved only consuming “alkaline” substances. This was for arthritis. The patient was also told to drink vast quantities of cider vinegar, cut out all citrus fruits and take loads of “supplements”. When I explained that this was illogical as vinegar is acetic ACID, I felt terrible. It was like telling a kid there’s no such thing as Father Christmas. Fortunately, the arthritis diagnosis was incorrect and the diet could safely be abandoned.

2 Trackbacks & Pingbacks

  1. Andy Burman Resigns From Ofquack | The Quackometer
  2. Are vitamin and mineral supplements a dangerous waste of time? « Dietethics

Leave a Reply. Please be civil, on topic, concise and sometimes funny.